C-Spine Clearance by ED TriageNurses_CAUTION-------------------------------

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----- Original Message ----
From: "Bjorn, Pret" <pbjorn at emh.org>
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Sent: Tuesday, May 12, 20092:32:12 PM
Subject: RE: C-Spine Clearance by ED TriageNurses_CAUTION-------------------------------


Long spine boards are transport devices.  They're just big frigging
splints with handles. 
*********************
Better yet
Long spine boards are extrication devices
(Trust me on that one)
 
 
 They can (and at my hospital, always do) come off
at the end of the secondary survey.  Five or ten minutes, tops.  We've
never chopped a cord. 
****************
Indeed
But then it only takes one
... that ruins the rest of YOUR week and HIS/HER life
 
Extremely rare iatrogenic event
But still
Not quite completely in the realm of the impossible
 
... that we all make an effort at summary immobilisation
 
 
 
 
Just as you can unwrap a splint from a wrist fracture and put it on a
pillow on the patient's lap, so can you take a spine fracture off a long
board.  (Okay, you can't put it on his lap; but you catch my meaning.)
Cripes, we keep KNOWN fractures lying in the ICU for days sometimes: bed
rest, log-roll only.  What's so different about the ED?  (If anything,
stretcher mattresses are more splinty.)  
**********************
Indeed
You guys have a different Elephant in the corner of your room
That we encounter on scenes
 
The co-existence of the two species of animal
And their diametrically different handling techniques
As always amazed me
 
This said
We (prehospital)
Immobilise
Because, I like telling my students...
 
We MOBILIZE our patients (move them from (usually) non plane surfaces into a 3 dimension transport space continuum ;-)
 
It has this significant
Is that our patients are splinted upon our arrival (to their car seat, floor, sidewalk, etc.)
Significant for the fact that they are no priorities to splint for splintying sake
 
... only for transport (time) sake
 
 
 
 
As for moving from one table to
another, we use a "smooth mover:" a big, slippery, and fairly flexible
plastic board.  With handles.  Wrap one in a bath blanket and put it on
the trauma stretcher before the patient arrives.  Voila.
********************
 
Nice
Here, based on non scientific elements patients
Are transferred either directly to a vacuum mattress
Or spine board / vacuum mattress
 
Voila ! ? (In deference to the local language only ;-)
 
 
In my opinion
The vacuum mattress is more of an in hospital or inter-hospital tool
More than a prehospital one
 
CULTURE
 
And (1) season(ed) practice
(also, perhaps, trickier X-Raying process)
 
Are the main obstacles to it's wider use


Even still, imagine: there's a car wreck near Edmundston, NB, Canada.
The clinic there receives one of the victims who has been appropriately
long-boarded by first responders at the scene, maybe up to an hour ago.
They do some plain films (I'm not sayin', I'm just sayin') and suspect a
subtle spine fracture.  The patient's an American, and anyhow, the
closest hospital of any size is just across the border in Fort Kent, ME,
USA.  Transfer is arranged, maybe another ninety minutes later.  The
patient is seen in FortKent.  An hour or two more.  They agree, but
there's no neurosurgeon in FortKent.  So they in turn transfer to
Bangor.  But it's snowing hard, so a typical four-hour drive turns into
five and a half.  Then he gets seen in our ED...  
**************************
Quebechas an underperforming EMS
But that patient would have stayed...
 
On the vacuum mattress
NB, Canada(our neighbor to the east)
If they are not there yet
Should probably be on the verge of adopting the vacuum mattress
 
 



Finally, the data may or may not show fracture mobility in a cervical
collar; but most of the data are from thoroughly relaxed injury models
(cadavers).  And there is little if any evidence of preventable
iatrogenic injury among collar wearers in vivo.
******************
A properly fitted C-Collar
Prevents 80% of range of motion
 
Beets the Culkin technique any time
And keeps the patient and staff attention to spinal precautions


 
 Charles

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